acne vulgaris

Question 1

types of scarring seen in acne vulgaris

Answer 1

ice pick scars
hypertrophic scars

Question 2

acne fulminans

Answer 2

v severe acne assoc with systemic upset (fever)

mx = admit, responds well to steroids

Question 3

acne vulgaris pathophys

Answer 3

obstruction of pilosebaceous follicles with keratin plugs which results in comedones, inflammation + pustules

colonisation by anaerobic bacteria propionibacterium acnes

Question 4

management of mild to moderate acne

Answer 4

12wk course of topical combination therapy should be tried 1st line
- topical adapalene + benzoyl peroxide
- topical tretinoin + clindamycin

benzoyl peroxide can be used as monotherapy if other contraindicated/patients dont want

Question 5

management of mod to severe acne

Answer 5

• 12wk topical combination therapy (same as mild-mod)
• COCP - alternative to antibiotics
• oral isotretinoin

Question 6

important points when using Abx in mx of acne

Answer 6

tetracyclines should be avoided in pregnancy + kids <12yrs
–> erythromycin may be used in pregnancy

Abx should only be continued for >6mnth in exceptional circumstances

topical + oral Abx should not be used in combo

Question 7

long term use of topical Abx complications

Answer 7

gram neg folliculitis

mx = high dose oral trimethoprim

Question 8

rules to reduce risk of antibiotic resistance developing in mx of acne

Answer 8

following should NOT be used -
- monotherapy with topical Abx
- monotherapy with oral Abx
- combo of topical + oral abx

Question 9

NICE referral criteria for acne

Answer 9

referral -
- acne conglobate
- nodulo-cystic acne

consider referral
- mild/mod not respond to 2x courses
- mod/sev not respond to tx
- acne with scarring
- acne with persistent pigmentary changes
- acne contributing to psychological distress

Question 10

14 weeks pregnant and thinks this may have triggered acne flare. She has used tretinoin and doxycycline to manage her skin successfully in the past but changed to her current regime of topical benzoyl peroxide with topical clindamycin 6 months ago as she wanted to conceive.

What is the most appropriate treatment option in this case?

Answer 10

continue topical benzoyl peroxide

change topical clindamycin to oral erythromycin

(severity of case is demonstrated by presence of nodules + resultant scarring, necessitating an escalation in tx)

Question 11

management of acne in pregnancy

Answer 11

oral erythromycin